{"id":5981,"date":"2020-03-24T09:16:55","date_gmt":"2020-03-24T13:16:55","guid":{"rendered":"http:\/\/www.silvercentury.org\/?p=5981"},"modified":"2020-03-24T09:16:55","modified_gmt":"2020-03-24T13:16:55","slug":"a-doctor-speaks-out-about-ageism-in-medicine","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2020\/03\/a-doctor-speaks-out-about-ageism-in-medicine\/","title":{"rendered":"A Doctor Speaks Out about Ageism in Medicine"},"content":{"rendered":"

In a wide-ranging interview, Louise Aronson, MD, a well-known geriatrician and author, talks about ageism among physicians, why it exists and what health care could and should be like for older people. <\/span><\/i>Kaiser Health News<\/span><\/i><\/a> (KHN) contributing columnist Judith Graham asks the questions in this eye-opening article that was posted on the KHN website on May 30, 2019. <\/span><\/i><\/p>\n

Society gives short shrift to older age. This distinct phase of life doesn\u2019t get the same attention that\u2019s devoted to childhood. And the special characteristics of people in their 60s, 70s, 80s and beyond are poorly understood.<\/span><\/p>\n

Medicine reflects this narrow-mindedness. In medical school, physicians learn that people in the prime of life are \u201cnormal,\u201d and scant time is spent studying aging. In practice, doctors too often fail to appreciate older adults\u2019 unique needs or to tailor treatments appropriately.<\/span><\/p>\n

Imagine a better way. Older adults would be seen as \u201cdifferent than,\u201d not \u201cless than.\u201d The phases of later life would be mapped, and expertise in aging would be valued, not discounted.<\/span><\/p>\n

With the growth of the elder population, it\u2019s time for this to happen, argues Dr. Louise Aronson, a geriatrician and professor of medicine at the University of California-San Francisco, in her new book <\/span>Elderhood.<\/span><\/i><\/p>\n

It\u2019s an in-depth, unusually frank exploration of biases that distort society\u2019s view of old age and that shape dysfunctional health policies and medical practices.<\/span><\/p>\n

In an interview, edited for clarity and length, Aronson elaborated on these themes.<\/span><\/p>\n

Q: How do you define \u201celderhood\u201d?<\/b><\/p>\n

Elderhood is the third major phase of life, which follows childhood and adulthood and lasts for 20 to 40 years, depending on how long we live.<\/span><\/p>\n

Medicine pretends that this part of life isn\u2019t really different from young adulthood or middle age. But it is. And that needs a lot more recognition than it currently gets.<\/span><\/p>\n

Q: Does elderhood have distinct stages? <\/b><\/p>\n

It\u2019s not like the stages of child development\u2014being a baby, a toddler, school age, a teenager\u2014which occur in a predictable sequence at about the same age for almost everybody.<\/span><\/p>\n

People age differently\u2014in different ways and at different rates. Sometimes people skip stages. Or they move from an earlier stage to a later stage but then move back again.<\/span><\/p>\n

Let\u2019s say someone in their 70s with cancer gets really aggressive treatment for a year. Before, this person was vital and robust. Now, he\u2019s gaunt and frail. But say the treatment works and this man starts eating healthily, exercising and getting lots of help from a supportive social network. In another year, he may feel and look much better, as if time had rolled backwards.<\/span><\/p>\n

Q: What might the stages of elderhood look like for a healthy older person?<\/b><\/p>\n

In their 60s and 70s, people\u2019s joints may start to give them trouble. Their skin changes. Their hearing and eyesight deteriorate. They begin to lose muscle mass. Your brain still works, but your processing speed is slower.<\/span><\/p>\n

In your 80s and above, you start to develop more stiffness. You\u2019re more likely to fall or have trouble with continence or sleeping or cognition\u2014the so-called geriatric syndromes. You begin to change how you do what you do, to compensate.<\/span><\/p>\n

Because bodies alter with aging, your response to treatment changes. Take a common disease like diabetes. The risks of tight blood sugar control become higher and the benefits become lower as people move into this \u201cold old\u201d stage. But many doctors aren\u2019t aware of the evidence or don\u2019t follow it.<\/span><\/p>\n

Q: You\u2019ve launched an elderhood clinic at UCSF. What do you do there?<\/b><\/p>\n

I see anyone over age 60 in every stage of health. Last week, my youngest patient was 62 and my oldest was 102.<\/span><\/p>\n

I\u2019ve been focusing on what I call the five P\u2019s. First, the whole person\u2014not the disease\u2014is my foremost concern.<\/span><\/p>\n

Prevention comes next. Evidence shows that you can increase the strength and decrease the frailty of people through age 100. The more unfit you are, the greater the benefits from even a small amount of exercise. And yet doctors don\u2019t routinely prescribe exercise. I do that.<\/span><\/p>\n

It\u2019s really clear that purpose, the third P, makes a huge difference in health and wellness. So I ask people, \u201cWhat are your goals and values? What makes you happy? What is it you are doing that you like best or you wish you were doing that you\u2019re not doing anymore?\u201d And then I try to help them make that happen.<\/span><\/p>\n

Many people haven\u2019t established priorities, the fourth P. Recently, I saw a man in his 70s who\u2019s had HIV\/AIDS for a long time and who assumed he would die decades ago. He had never planned for growing older or done advance-care planning. It terrified him. But now he\u2019s thinking about what it means to be an old man and what his priorities are, something he\u2019s finally willing to let me help him with.<\/span><\/p>\n

Perspective is the fifth P. When I work on this with people, I ask, \u201cLet\u2019s figure out a way for you to keep doing the things that are important to you. Do you need new skills? Do you need to change your environment? Do you need to do a bit of both?\u201d<\/span><\/p>\n

Perspective is about how people see themselves in older age. Are you willing to adapt and compensate for some of the ways you\u2019ve changed? This isn\u2019t easy by any means, but I think most people can get there if we give them the right support.<\/span><\/p>\n

Q: You\u2019re very forthright in the book about ageism in medicine. How common is that?<\/b><\/p>\n

Do you know the famous anecdote about the 97-year-old man with the painful left knee? He goes to a doctor, who takes a history and does an exam. There\u2019s no sign of trauma, and the doctor says, \u201cHey, the knee is 97 years old. What do you expect?\u201d And the patient says, \u201cBut my right knee is 97 and it doesn\u2019t hurt a bit.\u201d<\/span><\/p>\n

That\u2019s ageism: dismissing an older person\u2019s concerns simply because the person is old. It happens all the time.<\/span><\/p>\n

On the research side, traditionally, older adults have been excluded from clinical trials, although that\u2019s changing. In medical education, only a tiny part of the curriculum is devoted to older adults, although in hospitals and outpatient clinics they account for a very significant share of patients.<\/span><\/p>\n

The consequence is that most physicians have little or no specific training in the anatomy, physiology, pharmacology and special conditions and circumstances of old age\u2014though we know that old people are the ones most likely to be harmed by hospital care and medications.<\/span><\/p>\n

Q: What does ageism look like on the ground?<\/b><\/p>\n

Recently, a distressed, geriatrician colleague told me a story about grand rounds at a major medical center, where the case of a very complex older patient brought in from a nursing home was presented. [Grand rounds are meetings where doctors discuss interesting or difficult cases.]<\/span><\/p>\n

When it was time for comments, one of the leaders of the medical service stood up and said, \u201cI have a solution to this case. We just need to have nursing homes be 100 miles away from our hospitals.\u201d And the crowd laughed.<\/span><\/p>\n

Basically, he was saying: we don\u2019t want to see old people; they\u2019re a waste of our time and money. If someone had said this about women or people of color or LGBTQ people, there would have been outrage. In this case, there was none. It makes you want to cry.<\/span><\/p>\n

Q: What can people do if they encounter this from a doctor?<\/b><\/p>\n

If you put someone on the defensive, you won\u2019t get anywhere.<\/span><\/p>\n

You have to say in the gentlest, friendliest way possible, \u201cI picked you for my physician because I know you\u2019re a wonderful doctor. But I have to admit, I\u2019m pretty disappointed by what you just said, because it felt to me that you were discounting me. I\u2019d really like a different approach.\u201d<\/span><\/p>\n

Doctors are human beings, and we live in a super-ageist society. They may have unconscious biases, but they may not be malicious. So, give them some time to think about what you said. If after some time they don\u2019t respond, you should definitely change doctors.<\/span><\/p>\n

Q: Do you see signs of positive change?<\/b><\/p>\n

Absolutely. There\u2019s a much larger social conversation around aging than there was five years ago. And that is making its way to the health system.<\/span><\/p>\n

Surgeons are thinking more and more about evaluating and preparing older adults before surgery and the different kind of care they need after. Anesthesiologists are thinking more about delirium, which has short-term and long-term impacts on older adults\u2019 brains. And neurologists are thinking more about the experience of illness as well as the pathophysiology and imaging of it.<\/span><\/p>\n

Then you have the age-friendly, health-system movement, which is unquestionably a step in the right direction. And a whole host of start-ups that could make various types of care more convenient and that could, if they succeed, end up benefiting older people.<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Society gives short shrift to older age. This distinct phase of life doesn\u2019t get the same attention that\u2019s devoted to childhood.<\/span><\/p>\n

Read more A Doctor Speaks Out about Ageism in Medicine<\/span> ›<\/span><\/a><\/div>\n

<\/p>\n","protected":false},"author":41,"featured_media":5982,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0,"_FSMCFIC_featured_image_caption":"","_FSMCFIC_featured_image_nocaption":null,"_FSMCFIC_featured_image_hide":null,"footnotes":""},"categories":[6,4],"tags":[],"class_list":["post-5981","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ageism","category-issues-in-aging"],"cc_featured_image_caption":{"caption_text":"","source_text":"","source_url":""},"wps_subtitle":"A frank discussion of the biases that undercut older people\u2019s health care","_links":{"self":[{"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/posts\/5981","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/users\/41"}],"replies":[{"embeddable":true,"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/comments?post=5981"}],"version-history":[{"count":2,"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/posts\/5981\/revisions"}],"predecessor-version":[{"id":5984,"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/posts\/5981\/revisions\/5984"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/media\/5982"}],"wp:attachment":[{"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/media?parent=5981"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/categories?post=5981"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/78.142.243.82\/~silvercentury\/wp-json\/wp\/v2\/tags?post=5981"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}